But he cautions typical middle-aged patients. “Once they have that fusion, it can’t be undone,” Dr. Atlas said. “And it is likely that they will have future surgery down the road,” as a consequence of the instability fusion causes.
“If your goal is cure, that isn’t what this is going to offer,” he said.
Another option, for those willing to be patient, is intensive physical therapy. Large clinical trials found that those who take that route, as a group, have outcomes indistinguishable from those who have surgery.
But, Dr. Mirza, said, it has to be the right kind of physical therapy, strengthening muscles in the back, improving flexibility. Also, it’s unlikely Woods could have returned to the top of his sport with physical therapy alone.
“There is a tendency for rehab to involve passive treatments,” he explained, like ultrasound or traction or massage or dry needling. Those have not been shown to help.
The rehab also must be accompanied by behavioral therapy to teach patients not to be afraid of their back pain. “A lot of patients become terrified they will make things worse,” Dr. Mirza said. So they become deconditioned which does, in fact, make things worse.
On the other hand, suppose you don’t have time for all that physical therapy and counseling. You just want an operation to make the pain go away.
The problem is that you still need three to six months of physical therapy. After an initial period of near-immobility as the new bone in the cage in your spine heals, patients need to work on strength and conditioning.